Leor Sapir: How Consensus in Gender Medicine Was Manufactured
🔴 WATCH THE FULL EPISODE: https://ept.ms/4bCo1shShow more What looks like medical consensus can actually be manufactured. That’s what’s happened in gender medicine, argues Leor Sapir, a Manhattan Institute senior fellow.
Medical groups like the AAP & Endocrine Society often cite each other’s guidelines as “evidence,” creating a loop of circular citations that gives the appearance of scientific rigor. Internal communications show WPATH strategizing about getting major associations to endorse its guidelines to give them credibility, Sapir was.
Not a single group agreed to endorse them, Sapir says. But none criticized them either. Many organizations actively suppressed dissent from within their own ranks.
Why do such groups keep doubling down, even now? Perhaps it’s too hard to admit they were wrong after endorsing powerful, irreversible drugs and surgeries for kids, Sapir says.
He points to short-term incentives: The heads of these organizations often have a tenure of only one or two years, making it easier to just kick the can down the road.
He also describes “capture by committee”—a small, motivated bloc of activists inside large organizations overpowering a diffuse majority that’s less mobilized (or afraid to stick their neck out). The result? The organized minority wins.
Finally, medicine itself relies on a “chain of trust”: physicians in one specialty defer to the expertise of colleagues in another. When a particular field becomes captured, that chain can break — with far-reaching consequences. Show less
Medical societies say that these treatments are evidence-based and safe.
What are they basing that on?
And so, you know, we show in our review how groups like the American Academy of Pediatrics and WPATH and the Enderkin Society, they cite one another's guidelines as evidence.
As evidence, right?
So there's this kind of circular citations and you might call it credibility laundering.
WPATH actually, in those internal communications, its members explicitly discussed the importance of getting actual bona fide medical associations like the Enderkin Society and the AAP and the American Medical Association to endorse its guideline to give it the appearance of a credible medical guideline.
Interestingly, not a single medical group agreed to do it.
They simply didn't criticize WPATH guidelines, but they didn't endorse them either.
But nevertheless, this is how this area of medicine operates.
Everything is very kind of secretive behind the scenes.
And by the time things come to light, there's this kind of appearance of a consensus within the medical profession.
And in chapter 12 of our report, we also give lots of evidence of how medical societies internally suppress dissent and questioning from their own members.
I think it's a combination of kind of ideological commitments and sunk costs, right?
Once these organizations committed themselves to the practice, even if they committed themselves out of good faith and trust in people they thought were experts, once they've committed themselves to this, because of the nature of these procedures, you're talking about powerful, irreversible drugs and surgeries on kids.
It's very difficult for them to say, oops, we got this one wrong, even if they actually come to that realization.
I think a lot of what's going on in these organizations.
It's harder to double down.
You're right, it's hard, but doubling down seems somehow harder.
Well, I think it's a matter of short versus long-term incentives.
So just to give an example, the presidents of these organizations have a tenure of one year, maybe two years.
And so from their perspective, it's probably easier to just kick the can down the road and let the next guy deal with it.
So that's one possibility.
The other is what some of us call capture by committee, which it's a phenomenon that we see in Congress.
It's a phenomenon that I think exists in any large corporation.
And that is when you have a small group of highly motivated, kind of ideologically cohesive activists within a particular committee or institution within an organization, and they promote one particular viewpoint.
And those who prefer a different viewpoint are diffused.
They're not as organized.
They're not as motivated.
Maybe they're looking at thinking about other things.
Or maybe they're afraid of sticking their necks out, as is the case in this area.
It's always the first group that's going to prevail.
And so if you're the leadership of one of these organizations, your incentives are to defer to the small, vocal, highly attentive, highly motivated group, because the diffused, larger group that's not as motivated and not as attentive is not going to have your back.
So there's these collective action problems that occur naturally in organizations.
And I think that that goes a long way towards explaining what's going on here.
But I'd say one last thing is what I and others have been calling the broken chain of trust.
Medicine is a profession characterized by a high level of information asymmetry and specialization.
And that means that if you're a doctor in contemporary medicine, you know a lot within a very small silo of information, and you defer to colleagues who are specialists in other areas of medicine.